Provider Demographics
NPI:1619738440
Name:HARRIS, CHAZ JOSEPH
Entity Type:Individual
Prefix:
First Name:CHAZ
Middle Name:JOSEPH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12161 MERCADO DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1147
Mailing Address - Country:US
Mailing Address - Phone:716-868-2429
Mailing Address - Fax:
Practice Address - Street 1:12161 MERCADO DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1147
Practice Address - Country:US
Practice Address - Phone:716-868-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies